National immunization Programme and EPI schedule of Nepal

National immunization Programme of Nepal

Child health programme of Nepal includes Immunization, Nutrition, CBIMCI and Newborn Care. National Immunization Programme (NIP) is the priority program of department of Health Services, MOHP, Nepal and is considered successful public health intervention of Nepal. Currently eleven antigens are provided through the routine immunization under National Immunization programme of Nepal. There should be at least seven contacts of children (At birth, 6,10,14 weeks, 9, 12, 15 months) to health center to fully immunize as per national immunization programme of Nepal.

World Health organization established a program called Expanded Program on Immunization (EPI) in 1974 and many countries started implementing EPI. Expanded program on Immunization (EPI) including BCG,and DPT vaccines in Nepal started in Nepal in 1979 in three districts. However, EPI including BCG, DPT, oral polio vaccine, and Measles was expanded to all 75 districts by 1989 only. Since then, government of Nepal is providing free immunization services to everyone regardless of their gender, socioeconomic strata without any discrimination. It is one of the accessible services of Nepal and has reached to the 97% population. Nepal is believed to be one of the countries recognized for the well functioning immunization system. This is also considered as the most cost effective public health programme.

EPI Schedule of Nepal

The Comprehensive Multi Year Plan (cYMP), which is a 5-year plan of action, governs the National Immunization Programme (NIP) of Nepal. NIP is also guided by NHSP II, which focuses on increasing access and utilization of essential health care services to reduce disparities and considers Immunization as a package of free essential health care services. The Child Health Division (CHD) of the Ministry of Health and Population leads all immunization related activities and each district is responsible for the immunization coverage of that particular district (Annual Report 2011).

Goal of CMYP (comprehensive multi year plan 2011-2016)

• To reduce child, mortality, morbidity and disability associated with vaccine preventable diseases

Objectives and Strategies of CMYP

1. Objective 1: Achieve and maintain at least 90% vaccination coverage for all antigens at national and district level by 2016

Key strategies:

• Increase access and utilization to vaccination by implementing (Reaching every district) RED strategies in every district 
• Enhance human resources capacity for immunization management
• Strengthen immunization monitoring system at all levels
• Strengthen communication, social mobilization, and advocacy activities
• Strengthen immunization services in the municipalities

2. Objective 2: Ensure access to vaccines of assured quality and with appropriate waste management

Key strategies:

•      Strengthen the vaccine management system at all levels

3. Objective 3: Achieve and maintain polio free status

Key strategies:

•       Achieve and maintain high immunity levels against Polio by strengthening routine immunization and conducting high quality national polio immunization campaigns.
•       Respond adequately and timely to outbreak of poliomyelitis with appropriate vaccine
•       Achieve and maintain certification standard AFP surveillance

4. Objective 4: Maintain maternal and neonatal tetanus elimination status

Key strategies:

•        Achieve and maintain at least >80% TT2+ coverage for pregnant women in every districts
•        Conduct Td follow up campaigns in high risk districts
•        Expand school based immunization program
•        Continue surveillance of NT

5. Objective 5: Initiate measles elimination

Key strategies:

• Achieve and sustain high population immunity to reduce measles incidence to elimination level
• Investigate all suspected measles like outbreaks with program response
• Use platform of measles elimination for Rubella / CRS control

·      Continue case-based measles surveillance

6. Objective 6: Accelerate control of vaccine-preventable diseases through introduction of new and underused vaccines

Key strategies:

• Introduction of new and under-used vaccines (rubella, pneumococcal, typhoid, rota) based on disease burden and financial sustainability

7. Objective 7: Strengthen and expand VPD surveillance

Key strategies:

• Expand VPD surveillance to include vaccine preventable diseases of public health concern.
• Strengthen and expand laboratory support for surveillance.

8. Objective 8: Continue to expand immunization beyond infancy

Key strategies:

• Consider for booster dose of currently used antigen based on evidence and protection of adult from potential VPDs.

The current National Immunization activities are guided by those strategies to meet the objectives set in comprehensive multi year plan of Nepal.

Achievement till this date

Immunization services are provided free of cost through EPI clinics in hosptials, other health centres, mobile and outreach clinics, Non governmental organizations, private clinics. The government supplies all vaccines and immunization related logistics to these private institutions free of cost. All vaccines under National Immunization Programme are given free of cost to those private clinics, Nursing homes.

Nepal has attained polio free status in 27th March 2014, sustained maternal and neonatal tetanus elimination since 2005, and Japanese encephalitis is in control status and conducting measles case based surveillance to meet the target of elimination by 2019 (Annual Report 2070/71).

In the fiscal year 2071/72, The national coverage of BCG is the highest of all antigens indicating almost 99% coverage, while DPT‐HepB‐Hib and OPV‐ 3 coverage are more than 91%. The measles/rubella vaccine coverage is 88% and Td2+ coverage (Td2 and Td2+) coverage is 75%. The JE coverage (31 districts) is 75%.

Click here for Vaccine type and storage

Sources:

Jos Vandelaer, Jeffrey Partridge, Bal Krishna Suvedi,. Process of neonatal tetanus elimination in Nepal. Journal of Public Health. 2009.

Suvedi BK. Immunisation programme of Nepal: an update. Kathmandu University Medical Journal. 2003. Vol. 2 No. 3, Issue 7.

DOHS. Annual Report 2071/72.